Physical diagnosis skills: Clues from the patient's appearance and belongings

A loose belt, a cigarette burn, a ring, a bedside table covered with get-well cards - your patient's clothing and other belongings offer valuable diagnostic clues. Snaps and zippers in places where you would expect buttons may suggest chronic arthritis or motor dysfunctional disease. Cigarette burns in a circle around the neck (the so-called rosette sign) may signal abuse of CNS depressants. Black stains on underclothing usually suggest melena; red urine stains can occur with the use of phenazopyridine or rifampin. An indentation on the finger that suggests a missing wedding ring hints at divorce or marital problems. Odors also provide diagnostic clues. A sickly sweet breath odor suggests liver failure; the smell of garlic may be a sign of metal toxicity, or it may indicate the use of dimethyl sulfoxide.